MEDICARE: KELLY L DUNN MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0805X	Geriatric Psychiatry Physician

General Provider Information

NPI Number	:	1295044873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLY L DUNN MD PA

Provider Business Mailing Address
First Line	:	1696 W HIBISCUS BLVD STE A
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-2638
Country	:	US
Telephone Number	:	321-725-0554
Fax Number	:

Provider Business Practice Location Address
First Line	:	1696 W HIBISCUS BLVD STE A
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-2638
Country	:	US
Telephone Number	:	321-725-0554
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KELLY L DUNN
Credential	:	M.D.
Telephone Number	:	321-725-0554

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	09/30/2010

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